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URL: https://www.mwe.com/
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TELEHEALTH PRESCRIBING – WHAT’S PERMISSIBLE IN YOUR STATE?

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Telehealth’s state-by-state regulatory patchwork means that healthcare providers
must navigate a variety of regulations that govern which types of care can be
provided by virtual means, and even what modalities can be used in different
care settings.


For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.


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verified prior to reliance thereon, and an attorney should be consulted to
assess its applicability to any particular model of care. By accessing this
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understanding that this tool is not a replacement for legal counsel. There is no
guarantee that this research is up to date, as laws and regulations in this
space continue to evolve.

Report last updated December 2021; note this report does not generally reflect
waivers issued during the COVID-19 public health emergency, and this research
does not reflect any requirements of health plans, including Medicaid programs,
which may have their own modality requirements.


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Alaska
Physicians:
Alaska permits prescribing based on a telemedicine encounter (typically a secure
two-way videoconference or use of “store-and-forward” technology). Prescribing
solely on the basis of an online questionnaire or email without a prior
physician-patient relationship does not constitute acceptable standard of care
and is prohibited. It is also unprofessional conduct to prescribe based solely
on a patient-supplied history that a physician licensed in this state received
by telephone, facsimile, or electronic format.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Alabama
Physicians:
Alabama permits prescribing based on a telemedicine encounter. There is no
specific definition associated with “telemedicine” in statutes, regulations, or
guidance. Accordingly, physicians are held to the same standard of care
regardless of treatment modality.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Arkansas
Physicians:
A proper patient-provider relationship, which is required in order to prescribe,
may be established via telemedicine using real-time audio and visual
telemedicine technology. Prescriptions based solely in response to an internet
questionnaire, an internet consultation, or a telephone are prohibited.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Arizona
Physicians:
Arizona permits prescribing based on a telehealth encounter, including
audio-only encounters. Based on 2006 guidance, prescribing on the basis of a
questionnaire is not permitted.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



California
Physicians:
California permits prescribing on the basis of a telemedicine encounter,
including based on a self-screening tool or questionnaire, as long as the
licensee complies with the appropriate standard of care.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Colorado
Physicians:
Colorado permits prescribing based on a telehealth encounter, held to the same
standard of practice as in-person care. Prescribing on the basis of a
questionnaire is not acceptable standard of care.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Wyoming
Physicians:
Wyoming has a very broad definition of telemedicine, and it does not otherwise
regulate remote prescribing of non-controlled substances.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



West Virginia
Physicians:
A physician-patient relationship may be established via a real-time audio-visual
encounter, interactive audio-using store and forward technology, or audio-only
conversations in real time. A physician-patient relationship may not be
established through text-based communications such as e-mail, Internet
questionnaires, text-based messaging or other written forms of communication.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Wisconsin
Physicians:
Telemedicine is broadly defined to include services delivered via “electronic
communications.” Before delivering treatment, the physician must conduct a
patient evaluation. Issuing prescriptions based solely on a static questionnaire
is not sufficient.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Washington
Physicians:
There are no statutes or regulations that govern professional standards for
telemedicine services provided by physicians. guidance documents define
“telemedicine” broadly and permit physicians to establish a practitioner-patient
relationship via telemedicine. Patient completion of a questionnaire is
insufficient to establish a practitioner-patient relationship.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Vermont
Physicians:
Physician may prescribe after conducting an examination via telemedicine
(defined to require a live audiovisual encounter) or with “the use of
instrumentation and diagnostic equipment through which images and medical
records may be transmitted electronically.” An electronic, online, or telephonic
evaluation is inadequate for the patient’s initial evaluation.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Virginia
Physicians:
Physicians may prescribe after conducting an examination with “the use of
instrumentation and diagnostic equipment through which images and medical
records may be transmitted electronically.” For the purpose of Schedule VI
controlled substances, either “face-to-face interactive, two-way, real-time
communications services” or store-and-forward technologies are acceptable to
establish a bona-fide practitioner-patient relationship if, among other things,
“the patient has provided a medical history that is available for review by the
prescriber [and] (b) the prescriber obtains an updated medical history at the
time of prescribing.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Utah
Physicians:
Providers can establish a proper provider-patient relationship via telehealth,
which is defined to include both synchronous interactions and asynchronous
store-and-forward technology. Prescribing solely on the basis of an online
questionnaire or patient-generated medical history is prohibited.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Texas
Physicians:
A valid provider-patient relationship may be established via an audio-visual
encounter or asynchronous store and forward technology, provided that the
provider has access to (i) clinically relevant photographic or video images,
including diagnostic images; or (ii) the patient’s relevant medical records,
such as the relevant medical history. Telephone consults are permitted if used
in conjunction with asynchronous store-and-forward technology, and the provider
uses clinical information from images or medical records.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Tennessee
Physicians:
A physician-patient relationship may be established via a telemedicine encounter
whereby health information is transmitted via store and forward technology or
video conferencing. It is impermissible to prescribe based “solely on answers to
a set of questions” and prescriptions generally must be based on a “physical
examination.”

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



South Dakota
Physicians:
The definition of telehealth includes interactive audio-video, interactive audio
with store and forward, and remote patient monitoring. Any health care
professional who utilizes telehealth shall ensure that a proper health
provider-patient relationship is established prior to prescribing.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



South Carolina
Physicians:
Telemedicine is broadly defined to incorporate the practice of medicine via
“electronic communications.” An appropriate evaluation must be conducted before
diagnosing and treating patients, which must meet the standard of care. A simple
questionnaire without an appropriate evaluation is insufficient.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Rhode Island
Physicians:
Prescribing solely on the basis of an online questionnaire is considered
unprofessional conduct. A “physical evaluation” is required, though this can be
completed via telemedicine, which is defined as either two-way, audio-visual
encounter or store-and-forward technology. Prescriptions cannot be issued solely
on the basis of a questionnaire.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Pennsylvania
Physicians:
There are no applicable laws, regulations, or guidance that govern telehealth or
remote prescribing by physicians.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Oregon
Physicians:
The Oregon Medical Board has issued guidance indicating that telemedicine
“generally” includes “secure video conferencing.”

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Oklahoma
Physicians:
Telemedicine encounters must provide equivalent information to what would have
been provided in an in-person exam. Beginning in November, the definition of
telemedicine will explicitly include synchronous and asynchronous mechanisms.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Ohio
Physicians:
Physicians are permitted to prescribe without a “physical examination” as long
as they satisfy certain, enumerated requirements and “use appropriate
technology” to conduct all requirements as if the evaluation were in person. The
Medical Board has said the rule is “silent” on whether a visual connection is
required.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



New York
Physicians:
Telehealth is limited to telemedicine, store and forward technology, remote
patient monitoring and audio-only telephone communication. Telemedicine is
defined to require an audiovisual interaction.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Nevada
Physicians:
The term telehealth is defined to incorporate “information and audio-visual
communication technology.”

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



New Jersey
Physicians:
Telemedicine services shall be provided using interactive, real-time, two-way
communication technologies, but audio-only telemedicine combined with
asynchronous store-and-forward is permissible if the provider accesses and
reviews the patient’s medical records and concludes that the provider can “meet
the same standard of care” as if the services were provided in person.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



New Hampshire
Physicians:
Telehealth and telemedicine include the use of audio, video, or other electronic
media. Providers must establish a provider-patient relationship via an
audiovisual encounter in order to prescribe.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Nebraska
Physicians:
The definition for “telehealth” incorporates both synchronous and asynchronous
modalities.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



North Dakota
Physicians:
Licensees can prescribe on the basis of a telemedicine encounter, which is
defined to include interactive patient encounters, as well as asynchronous
store-and-forward technologies. An examination based solely on a static
questionnaire or audio conversation is insufficient to meet the standard of care
for treatment via telemedicine.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



North Carolina
Physicians:
The Board prohibits prescribing on the basis of answers to a questionnaire. It
also states that a “physical examination” is “ordinarily” required, though it
leaves open the possibility that prescriptions may be issued pursuant to a
telemedicine encounter (which is broadly defined).

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Montana
Physicians:
The definition of “telemedicine” is broadly defined and incorporates
videoconferencing, audio-only conversations, and “store-and-forward,” which is
broadly defined to include electronic information that is reviewed by a health
care provider at a later date. The definition of “telemedicine” excludes emails,
instant messaging conversations, and fax.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Mississippi
Physicians:
Physicians must perform an examination prior to providing treatment, which does
not need to be in-person if the technology provides the same information “as if
the exam had been performed face-to-face.” In addition, a valid physician
patient relationship requires a “physical examination.” Prescribing based solely
on the answers to a set of questions is unprofessional conduct.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Missouri
Physicians:
Prior to prescribing a drug via telemedicine, a physician must establish a valid
physician patient relationship, which includes a “physical examination”
(undefined). In addition, prescribing solely on the basis of an internet
questionnaire is prohibited.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Minnesota
Physicians:
The term “telemedicine” is broadly defined, and includes interactive,
audio-visual encounters and the use of store-and-forward technology.
Store-and-forward technology is not specifically defined.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Maine
Physicians:
A 2021 statute defines telehealth to include both synchronous and asynchronous
encounters. Current regulations applicable to physicians specify that a static
questionnaire is insufficient to form the basis of a prescription. It
distinguishes this with an “adaptive, interactive, and responsive online
interview,” suggesting that the former is permissible. It is unclear whether
telehealth regulations applicable to physicians will be revised in light of the
new telehealth statute.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



New Mexico
Physicians:
Physicians may only prescribe via a telehealth encounter that incorporates
face-to-face, videoconferencing technology. In addition, prescribing based
solely on an online questionnaire is expressly identified as insufficient.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Maryland
Physicians:
A 2020 law permits prescriptions to be issued on the basis of synchronous
(defined solely as “real time”) or asynchronous encounters. The Board of
Medicine has historically had regulations that are more strict than the
provisions in the new statute (including requiring an audio-visual encounter),
although these are arguably superseded by the new law.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Massachusetts
Physicians:
Telehealth is defined to include the use of synchronous and asynchronous
modalities, as well as audio-only telephone and online adaptive interviews.
Based on recent guidance from the Board of Registration in Medicine, a
face-to-face encounter is not required.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Louisiana
Physicians:
Telemedicine is defined to include electronic communications, information
technology, asynchronous store-and-forward transfer technology, or technology
that facilitates synchronous interaction between a physician at a distant site
and a patient at an originating site, or audio-only under certain circumstances.
Email and text messages that are not HIPAA-compliant do not constitute
“telemedicine.” In addition, based on current regulations, an online, electronic
or written mail message does not satisfy the standards of appropriate care.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Kentucky
Physicians:
Telehealth is defined to include “interactive audio, video, or other electronic
media.” An electronic, online, or telephonic questionnaire is considered
insufficient for the initial evaluation of a patient or any follow-up
evaluation.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Kansas
Physicians:
The term “telemedicine” is defined to require interactive modalities. In
addition, Kansas pharmacy laws prohibit prescriptions based on an online
questionnaire.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Indiana
Physicians:
Providers can prescribe on the basis of a telehealth encounter, which is defined
to include both videoconferencing and store and forward technologies. Certain
technologies are explicitly excluded from the definition of “telemedicine,”
including emails, instant messaging, fax, questionnaires, and internet
consultations. Accordingly, these technologies may not be relied upon as the
sole basis to issue prescriptions.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Illinois
Physicians:
Health care professionals are broadly permitted to use telehealth to perform
services, which includes telemedicine. Telemedicine, in turn, is defined broadly
in the Medical Practice Act to include “telephonic” and “electronic” means.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Idaho
Physicians:
A provider-patient relationship must be established using two-way, audio-visual
technology. Moreover, treatment based solely on an online questionnaire does not
constitute an acceptable standard of care.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Iowa
Physicians:
Physicians may establish a provider-patient relationship and prescribe via
telemedicine, which is defined to include audio-visual communications and
asynchronous store-and-forward technologies. A static questionnaire is
insufficient to form the basis of a prescription, in contrast to an “adaptive,
interactive, and responsive online interview,” suggesting that the former is
permissible.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Hawaii
Physicians:
Based on language in the commercial coverage statute, a provider-patient
relationship may be established via telehealth. In addition, prescribing on the
basis of a telehealth encounter is permissible provided that the standard of
care is met. Prescribing solely on the basis of an online questionnaire is
prohibited without a prior physician-patient relationship.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Georgia
Physicians:
Georgia permits prescribing through electronic means. Such treatment is
permissible if the physician has previously personally seen and examined the
patient, is providing medical care on behalf of another provider that has
personally seen the patient, or is able to examine the patient using technology
or peripherals that are equal or superior to personal examination within the
provider’s standard of care.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Michigan
Physicians:
Physicians are permitted to prescribe via telehealth, which is defined broadly.
It includes telemedicine, which is defined to include interactive audio or
video, as well as online messaging.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Florida
Physicians:
Florida permits prescribing based on a telehealth encounter, which includes
synchronous and asynchronous communications. Audio-only calls, email messages,
and fax transmissions are excluded from the definition of telehealth.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Delaware
Physicians:
Providers may establish a provider-patient relationship via telemedicine.
Diagnoses must be based on an encounter using audio and visual communication.
Prescribing solely on the basis of an online questionnaire, Internet consult, or
telephone consult is prohibited without a prior physician-patient relationship.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



District of Columbia
Physicians:
Physicians are required to use real-time telemedicine to establish a
provider-patient relationship if they have not conducted a prior in-person
examination with the patient. Real-time is defined to require “near immediate
feedback.”

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.



Connecticut
Physicians:
Connecticut permits prescribing based on a real time, two-way interactive
communications or store-and-forward technologies. Fax, audio-only phone,
texting, and email are excluded from the definition of “telehealth.” Telehealth
providers must also have access to the patient’s medical history and medical
record.

For our full Rules Governing Telehealth Modalities and Patient-Provider
Relationships Report click below to download.






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